The surgeon’s domain

When you’re entering the OR, you’re entering a domain under the supreme reign of the surgeon. Not that you could ever fail to notice.

When I’m filming an operation, it is often the case that the surgeon has not requested my presence. I basically have access to to film all operations as long as the patient has signed a consent form. So if a project needs a video of a gastrectomy or a liver embolization we’ll talk to the patient and then call the surgeon to check if it’s OK for him or her. If he says “no”, I don’t show up, of course. But even if he’s OK with it, there’s a huge difference between that and if he had requested my presence.

When I step into the OR, I step into the workplace of a number of people, but it’s the surgeon who’s the boss of the room. His word is the law. More often than not, surgeons have larger than average egos. I guess it’s both a question of the kind of persons who pursue a surgical career, and a side effect of the actual importance of the job. So a lot of surgeons like to boss people around, but when an outsider steps into the room with a camera, authority clashes with vanity.

One of the first operations I ever filmed is a good example. It was a hysterectomy to remove a uterine sarcoma. A gynoncologist on my project was going to operate, and we were OK to go. I went to the OR, rigged my equipment and then another surgeon entered. “What is this?” he said briskly, “Who are you”. A bit baffled I answered something about the other surgeon agreeing to this before he cut me off. “No,” he said. “This is not OK. I decide who I want in my OR. I’ll kick you out if I want to.” Something had come up that prevented our guy to operate, and there had been a last minute change.”Mhm. OK,” I muttered, but stayed.

Obviously irritated the surgeon started to work. I started to film, not sure where this was going to end. After about 15 minutes of silence the surgeon suddenly said, “Hrmpf. Well, while you’re here I might as well tell you what I’m doing.” And then he proceeded with the most thorough explanation of a procedure I’ve heard to date.

I’ve seen the same duality of character again and again over the years. Most surgeons want to be in charge and not have strangers invade their OR. But at the same time they’re flattered by the presence of the camera, and the opportunity to show their skills.

It seems that as a whole, the entire O.R. team is often suspicious of strangers. We often feel very protective of our patients, and until we are familiar with someone and are confident that they understand sterile technique and that they maintain respect for patients, they often get the scrutinizing stink eye.

I understand those concerns completely, and it’s always important for me to emphasize that I’m employed by the hospital and not some outside company. That I understand sterile technique and is bound to the same professional secrecy as them.

Knowing this the nurses are always forthcoming and helpful, but there’s still some surgeons who only greet me with a small nod, implying “I acknowledge your presence, but I’m not necessarily happy about it.”